コレステロール添加食投与ラットの肝脂肪蓄積に及ぼす焙煎度の異なるコーヒー豆抽出物の影響

We examined the effects of the extracts of coffee beans roasted at different degrees on the lipid metabolism of rats fed cholesterol（Cho）-added diets. Fatty livers along with a significant increase in triacylglycerol（TG）and Cho levels were observed in rats belonging to the C（Cho-added diet）group. Although the Cho level was slightly decreased in the S group, with the addition of shallow-roasted coffee bean extract to Cho-added diet, carnitine palmitoyltransferase activity showed a significantly high value, and the amount of TG was significantly reduced. In contrast, with the addition of deep-roasted coffee bean extract to Cho-added diet in the D group, fatty acid synthase activity showed a significantly lower value, TG and Cho levels were significantly reduced, and a reduction in fatty liver was observed. Moreover, since the levels of lipid peroxide in plasma and liver decreased in both S and D groups, compared to the Cgroup, there is a possibility that roasted coffee bean extracts may suppress the progression to nonalcoholicsteatohepatitis.原著論

妊娠中期の妊婦に発症し，体外式腹部超音波検査にて術前診断しえた虫垂憩室炎の一例

虫垂憩室炎は比較的稀な疾患であり，急性虫垂炎と比べ，穿孔率が高いがその術前診断は難しい．体外式腹部超音波検査で術前に診断した虫垂憩室炎の1症例を経験したので，文献的考察を加えて報告する．症例は24歳，妊娠25週５日の女性．腹痛を主訴に近医を受診したところ，急性虫垂炎の疑いで当院へ紹介受診となった．体外式腹部超音波検査で，虫垂憩室炎と診断し，緊急手術となった．切除標本の病理学的検査により，虫垂憩室炎と確定診断された．Preoperative diagnosis of appendiceal diverticulitis is considered difficult. Differentiation between acute appendicitis and appendiceal diverticulitis is clinically important because the latter condition has a higher risk of perforation. We report a case of a 24-year-old pregnant (25 weeks and 5 days of gestation) woman who complained of right lower quadrant pain. After visiting a primary care doctor, she was referred to our hospital with suspected acute appendicitis. Ultrasound showed that the appendix was swollen and there were several low echoic lesions in the vicinity of the point of the appendix. Blood flow was shaped in an arc around the low echoic lesion as shown by Doppler color flow imaging. We observed thickness and hyperechoic change, which was affected by inflammation in the mesoappendix. She underwent appendectomy and a pathological examination of the resected specimen confirmed the diagnosis of appendiceal diverticulitis

上腸間膜動脈限局性の高安動脈炎の一例

腹痛を呈した上腸間膜動脈（superior mesenteric artery: SMA）に限局した高安動脈炎の一例を経験したので，文献的考察を加えて報告する．症例は17歳，男性．心窩部痛・右背部痛を認め，近医を受診し，その際施行した体外式腹部超音波検査（ultrasound: US）でSMA の壁肥厚が疑われ，当院総合診療科を紹介受診した．身体診察では上腹部正中に軽度圧痛を認め，血液生化学検査では血沈（60min）35mm, CRP 3.92mg/dL と軽度上昇を認めた．US では，腹痛を訴える部位に一致してSMA 起始部にびまん性の壁肥厚を認め，血管炎が疑われた．胸部造影・上腹骨盤部単純造影CT 検査（computed tomography: CT）ではSMA 周囲に造影効果を認める軟部影を認め，18F-FDGPET（18F-fluorodeoxyglucose positron emission tomography: PET）/CT 検査ではSMA 起始部付近に腫大と軽度のFDG 集積を認め，動脈炎による集積で矛盾しない所見であった．以上のことから，SMA に限局した高安動脈炎と診断した．ステロイド治療を開始し腹痛は速やかに消褪すると共に，US 所見にも改善がみられた．We report the case of a 17-year-old male who visited a hospital complaining of epigastric and right back pain. Thickening of the wall of the superior mesenteric artery （SMA) was suspected by ultrasound （US), and he was referred to our hospital. Physical examination revealed median upper abdominal tenderness. Laboratory tests showed an erythrocyte sedimentation rate （60 min) of 35 mm and C-reactive protein of 3.92mg/dL. US examination in our hospital showed diffuse wall thickening at the origin of the SMA. Because the location of the pain and the affected area identified by US were the same, we suspected angiitis. An enhanced area around the SMA was revealed by computed tomography. 18F-fluorodeoxyglucose positron emission tomography/computed tomography showed swelling at the origin of the SMA and mild accumulation of fluorodeoxyglucose. He was diagnosed with Takayasu arteritis involving the SMA. Steroid therapy was started, and his abdominal pain and US findings improved

胃十二指腸運動機能の推移が評価できたCeliac Artery Compression Syndromeの1例

症例は40歳代の女性.X-1年1月頃より食後の心窩部や左季肋部の痛み,張り感などが出現し,上部消化管内視鏡検査で症状の原因となる器質的疾患は指摘されないため,X年10月当科に紹介された.体外式超音波検査(US)で腹腔動脈(CA)の呼吸性変位が指摘され,CAの血流測定を行ったところCeliac Artery Compression Syndrome (CACS)と診断された.本人が手術を希望せず,約2年半経過した現在も上腹部症状に対して内服薬のみ投与している.症状に胃十二指腸運動機能異常の関与も疑われたため,US を用いた胃十二指腸運動機能検査は4回施行され,その結果は内服薬の選択に利用された.運動機能検査の結果は4回目が最も改善しており,同時に施行した症状問診票の腹痛症状は4回目が最も軽かった.比較的長期にわたり症状と消化管運動機能の推移を観察したCACS症例の報告は過去になく,本稿が最初の報告である.We reported a case of a woman in her 40\u27s with celiac artery compression syndrome (CACS). She presented a dull pain and fullness in the upper part of her abdomen during and soon after eating. Blood and urine examinations revealed no obvious abnormalities, and upper gastrointestinal endoscopy indicated no obvious causes for the symptom. After a routine abdominal ultrasound (US), measurement of celiac artery blood flow showed high bloodflow velocity, which met the US diagnostic criteria for CACS. The evidence of CACS was supported by contrast-enhanced computed tomography, showing an obvious narrowing of the celiac artery in the expiration phase. Since she did not accept surgical therapy, treatment using oral medicine continued for about 2 years and six months. Meanwhile, the US examination for evaluating gastro-duodenal motility was performed 4 times. This is the first report that showing long-term progress of the symptoms and gastro-duodenal motility in this CACS patient

当院における便潜血陽性者に対する大腸CT(CTコロノグラフィー)検査の有用性:大腸がん検診への導入と課題

大腸がん検診におけるスクリーニング検査としての大腸CT(CT colonography: CTC)検査の有用性を検討するために,当院における便潜血陽性者に対するCTCと大腸内視鏡検査の精度比較を行った.2009年7月から2014年1月までに川崎医科大学附属病院で施行されたCTC検査673件中,スクリーニング目的で行われた411件の中で便潜血陽性者に対して行われた183名を対象とした.全例CTC検査と同日に全大腸内視鏡検査も行った.対象とする病変は内視鏡観察あるいは病理組織学的に腺腫,がんと診断されたものとした.CTCの前処置は,経口腸管洗浄剤に水溶性造影剤による標識(タギング)を付けて行った.CT装置は16列Multi-slice CT(MSCT),腸管拡張は自動炭酸ガス注入器を使用した.CTC読影は,まず仮想内視鏡(3D)で行い,後に多断面再構成像(Multi-planar reconstruction: MPR 像(2D))を行う3D primary 法で行った.183名(男性98名,女性85名,年齢40～86歳,平均年齢62.1歳±0.8歳)のうち,病変を認めなかったのは87名(47.5%)であり,病変を認めたのは96名(53%)であった.総病変数は191個であり,うち6mm以上の病変は77個(40%)で,そのうち10mm以上のものは46個(24%)であった.大腸癌は25例(全病変中13%)で,うち腺腫内癌16例(全病変中8%)であった.側方発育型腫瘍は8例(4%)(大きさ平均17mm)であった.病変のうち,内視鏡的切除が行われたものは34病変であり,手術が行われたものは22病変であった.病変形態別による描出率は隆起型病変80%で,平坦型病変65%であった.病変サイズ別の精度は10mm以上の病変(n=46)で感度96%,陽性適中率98%であり,6mm以上の病変(n=77)で感度83%,陽性適中率79%であった.CTCは便潜血陽性者において良好な精度を示し,大腸がんスクリーニング法としての可能性がある.The purpose of this study was to estimate the sensitivity and specificity of CT colonography (CTC) for colorectal cancer screeing following positive fecal occult blood test (FOBT) in Japan. To compare detection rates of colorectal cancer and adenoma between CTC and optical total colonoscopy (TCS). This study included 183 patients with positive result of FOBT in Japanese colorectal cancer screening program. The patients had both CTC and TCS on the same day. 96 patients (53%) had colorectal lesions, on the other hand 87 patients had no lesions. The total number of lesions was 191, including 77 lesions 6 mm in maximum diameter and larger, including 46 lesions 10 mm and larger